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Inspection on 22/08/05 for Chestnuts Nursing & Residential Care Home (The)

Also see our care home review for Chestnuts Nursing & Residential Care Home (The) for more information

This inspection was carried out on 22nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The standard of care planning is maintained to a good standard and resident`s needs are clearly set out and staff have the information they need to satisfactorily identify and meet residents needs. The meals in the home are well presented and offer both choice and variety for residents, with individual preferences being catered for. The home is well maintained both internal and external. There is a secluded and well-landscaped garden to the rear of the premises, which is fully accessible to all people living in the home. It provides a very pleasant area for residents and their relatives to sit in when weather permits.

What has improved since the last inspection?

All requirements made at the last inspection around the management of medication have been satisfactorily addressed. Nursing staff have attended training in wound management, prevention of falls and specialised feeding. Care staff have done training in areas such as mouth care; continence management; diet and feeding; and control of infection. The home was recently awarded second place in this years `Redbridge in Bloom" competition for their outside floral displays.The Chestnuts Nursing & Residential Care HomeVersion 1.30 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.docPage 7

What the care home could do better:

It is of serious concern that there has been no registered manager in the home since the previous manager left, some ten months ago, and the Commission are in ongoing discussions with the registered provider. It is acknowledged that the registered provider has endeavoured to recruit a suitably experienced and qualified person. Residents need more support to exercise choice and control over their lives and account must be taken of the variation in preferences and capacity of individuals living in the home. There must be sufficient staff at mealtimes to make sure residents are assisted were necessary. More consideration must be given to planning individual and small group activities so that all residents have a stimulating and varied choice of activities.

CARE HOMES FOR OLDER PEOPLE The Chestnuts Nursing & Residential Care Home 63 Cambridge Park Wanstead London E11 2PR Lead Inspector Gwen Lording Unannounced Inspection 22nd August 2005 11.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Chestnuts Nursing & Residential Care Home Version 1.30 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Page 3 SERVICE INFORMATION Name of service The Chestnuts Nursing & Residential Care Home Address 63 Cambridge Park, Wanstead, London E11 2PR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8989 3519 020 8530 6211 Ms Avril Stein No manager currently registered CRH Care Home 51 Category(ies) of OP Old age (51) registration, with number PD Physical disability (6) of places The Chestnuts Nursing & Residential Care Home Version 1.30 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Page 4 SERVICE INFORMATION Conditions of registration: The service can only admit people in the category of PD (Physical Disability) who are 55 years of age and above. Date of last inspection 01 February 2005 The Chestnuts Nursing & Residential Care Home Version 1.30 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Page 5 Brief Description of the Service: The Chestnuts is a care home registered to provide accommodation with personal care and nursing for up to fifty-one residents, including six places for residents over 55 years who have a physical disability. The registered provider is the sole proprietor. The large property is situated in its own grounds with a large secluded garden to the rear. The majority of rooms are single and all rooms have en suite facilities. There are two passenger lifts, with access to all floors. The home is set well back on a busy main road in Wanstead, in the London Borough of Redbridge. The home is well served by public transport and close to shops and other local amenities. The Chestnuts Nursing & Residential Care Home Version 1.30 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day, commenced at 11am and lasted five and a half hours. The Inspector spoke to a number of residents on each floor of the home. Discussion took place with the deputy manager, administrative, catering, domestic staff and several members of nursing and care staff. The inspector met briefly with the registered provider at the end of the inspection. A tour of the home was made and a number of staff and care records were looked at. What the service does well: What has improved since the last inspection? All requirements made at the last inspection around the management of medication have been satisfactorily addressed. Nursing staff have attended training in wound management, prevention of falls and specialised feeding. Care staff have done training in areas such as mouth care; continence management; diet and feeding; and control of infection. The home was recently awarded second place in this years ‘Redbridge in Bloom” competition for their outside floral displays. The Chestnuts Nursing & Residential Care Home Version 1.30 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chestnuts Nursing & Residential Care Home Version 1.30 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Appropriate pre-admission assessments are carried out for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. EVIDENCE: Individual records are kept for each resident and eight files were examined. All records inspected had assessment information recorded and the information had been used to continue assessment following admission to the home and develop written care plans. The records showed that residents, where capable and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also on file. The home does not offer intermediate care. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents’ health, personal and social care needs are clearly set out in an individual plan of care and provide staff with the information they need to satisfactorily identify and meet residents needs. However, any changes in an individuals treatment regime, as indicated following specialist appointments, must be actioned and followed up accordingly to ensure that there is no delay in a resident receiving the required treatment according to their need. There are clear medication policies and procedures for staff to follow, and the review of medication records show that staff are following the policies and procedures, and residents were being safeguarded with regard to their medication. Residents are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. EVIDENCE: Individual plans of care were available for each resident and the care plans of ten residents were examined. The records for these residents were found to be The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 11 generally detailed and comprehensive, and followed on from a full assessment of the resident’s needs. The records indicated that residents are seen by other health care professionals such as dentists, chiropodists, specialist nurses and doctors. There was evidence that care plans are reviewed on a monthly basis and updated to reflect changing needs. However, one resident had attended an appointment on the 8th August at an orthopaedic clinic. She had been prescribed a course of anti-biotics but the medication was still not available some fourteen days later. In discussion with the deputy manager it was evident that the delay in commencing the medication was due to difficulties in communication between the GP and the orthopaedic clinic doctor. Staff must ensure that any changes in treatment are effected without delay and that appropriate and timely action is taken to address such delays to ensure that the health care needs of residents are appropriately met. Staff must clearly record the reasons for any delay occurring in the provision of treatment prescribed and what action they have taken to address the concern with the professionals involved. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to promote their dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. Residents spoken to said that all staff were respectful and thoughtful when attending to their personal care. At the last inspection a number of requirements were made around recordings on the Medication Administration Record (MAR) charts. Examination of the MAR charts showed that these requirements had been complied with. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 The lifestyle within the home matches the expectations and preferences of some residents, but others need support to exercise choice and control over their lives within their individual capabilities. The meals in the home are well presented and offer both choice and variety for residents living in the home with individual preferences being catered for. However, there were not sufficient staff at mealtimes to assist residents where necessary. EVIDENCE: Older people moving into care homes will have differing expectations and preferences as to the lifestyle within the home. Some people will want a wellorganised life, whilst others will want to maintain a level of independence. The home needs to take into account the variation in preferences and capacity of individuals living in the home. At the last inspection a requirement was made around the philosophy of the home being conducted as to maximise residents individual capacity to exercise personal autonomy and choice. However, the Inspector noted that there are still notices displayed in the home of either a prohibitive or instructive nature. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 13 For example, ‘Service Users are not allowed to use the lift unless accompanied by a health care assistant’ and a notice in one of the bathrooms instructs people that ‘only liquid soap is to be used, not solid soap’. Through discussion with the deputy manager it is apparent that these instructions are intended to address potential health, safety and welfare concerns i.e. the safety of residents whilst operating the lift. It is also acknowledged that the registered provider has the responsibility to ensure, so far as is practicable the health, safety and welfare of residents in the home. However, this does not recognise or take into account the individual capacities of residents living in the home. Any such decisions must be based on a risk assessment of the individual’s vulnerability with evidence of regular reviews. This will ensure that residents are encouraged and supported to exercise choice and control over their lives, whilst equally ensuring and maintaining safe working practices. The chef has been at the home for a number of years and knows what each resident likes to eat and which residents require a special diet, for example if they are diabetic. Those residents spoken to said they enjoyed the food. Typical comments were: “The food is well cooked” and “There is always a good choice”. At the lunchtime meal freshly prepared side salads and fresh fruit were available. Wine and beer are offered at the main meal. Staff make a note of residents birthdays and a cake is always prepared by the chef when a resident celebrates a birthday. Meals are served in the dining rooms or residents may choose to eat in their rooms. A number of residents remain in their lounge chairs and eat off small tables placed in front of them, though it is not clear if this is through choice. Staff are on hand to assist individuals with eating when necessary. Many of the residents require either supervision by staff or assistance with eating. The Inspector was present when lunch was being served in the first floor lounge. All the residents in this lounge eat from small tables placed in front of them, though there is a separate dining room on this floor, which was not used during the visit. At least eight of the residents in this lounge required assistance with eating and several others required degrees of supervision by staff. All of the residents were served a meal and a dessert; three were being assisted to eat by staff whilst the meals of five other residents were left to get cold, as there were no staff available to assist them with eating. The registered provider must review the staffing levels and working practices of staff to ensure that there are sufficient staff at mealtimes, to assist service user where necessary, whilst encouraging independent eating for as long as possible. The home employs two part time activity co-ordinators. A range of social and leisure activities are arranged and available in the home and to a limited degree outside the home. There is a varied programme of activities available for larger groups. More consideration must be given to planning individual and The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 14 small group activities to ensure that all residents have a sufficiently stimulating and varied choice of activities. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The information in the complaints policy/ procedure must be amended to provide residents and their relatives with the appropriate information and ensure that their complaints are dealt with promptly, effectively and to their satisfaction. Nursing and care staff receive training in adult protection/ abuse awareness. There has been no progress in this training being extended to all staff working in the home to ensure that there is a proper response to any concerns about the welfare of residents. EVIDENCE: The home has a complaints policy/ procedure and the records inspected indicate the number of complaints received and includes details of investigation, any action taken and the outcome for the complainant. However, some of the residents would not have the capacity to use a written, formal process. Those residents spoken to, who were able to express a view said that the deputy manager and the nurses were responsive to any concerns raised and were confident that “things would be sorted out” to their satisfaction. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 16 The complaints policy must be amended to include information for referring a complaint to the Commission, at any stage, should the complainant wish to do so. The home has a written policy and procedure for dealing with allegations of abuse and whistle blowing and there is an ongoing programme of training in Adult Protection/ Abuse Awareness for nursing and care staff. At the last two inspections a requirement has been made for this training to be extended to all staff working in the home including administrative and ancillary staff, and this has not been progressed. It is a requirement that this is considered to be a priority training need for all staff in the home and must be complied with by the new timescale. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26 The overall atmosphere in the home is very welcoming, with access to indoor and outdoor communal facilities which adequately meet the needs of the people living in the home. EVIDENCE: There is an ongoing programme of renewal for the fabric and decoration of the premises and the standard of the environment within the home provides residents with an attractive and comfortable place in which to live. The external areas of the home are very well maintained and there is a secluded, landscaped garden to the rear of the property, which is fully accessible to residents. The home was recently awarded second place in this years ‘Redbridge in Bloom’ competition. Bathrooms on all floors were being used to store equipment such as, wheelchairs, hoists and other sundry items of equipment. Therefore these The Chestnuts Nursing & Residential Care Home Version 1.30 Page 18 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc bathrooms are not available for residents who might wish to use them independently. Alarms in residents’ bedrooms were not always within their reach, particularly during the daytime, when residents were seated away from the alarm cord located near their bed. It is important that staff regularly check to ensure residents have the means to summon assistance, should they need it. At the beginning of the inspection, there were a number of isolated areas were there was a strong odour of urine, but this was rectified as beds were changed and rooms cleaned. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The home employs sufficient staff to meet the personal and nursing care needs of the residents. However, the increased needs of residents at mealtimes may mean staffing levels being increased at these times so that residents are supported and assisted appropriately. Residents benefit from a committed team of staff at the home who have the skills and training to meet their needs. EVIDENCE: The staffing levels of qualified nurses and care staff were sufficient to meet the nursing needs and personal care needs of residents, with the exception of mealtimes, which has already been commented on earlier in this report. In addition to qualified nurses and care staff Chestnuts employs activity coordinators, catering, laundry, housekeeping, maintenance and administrative staff. In discussion with staff it was evident that they fully support the main aims and values of the home. Staff training records showed that care staff had done training in areas such as mouth care; continence management; diet and feeding; and hand washing/ control of infection. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 20 Qualified nursing staff had attended training in wound management; prevention of falls and PEG feeding. All newly employed staff undertake four day induction training in the first week of their employment in the home. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 and 36 In the prolonged absence of a registered manager there is no clear leadership, guidance and direction to staff to ensure that residents receive consistent quality of care. This may potentially result in some practices that do not promote and safeguard the health, safety and welfare of people using the service. EVIDENCE: There is no registered manager and this has been the case since the previous manager left in October, 2004. Whilst residents and staff spoken to made positive comments about the deputy manager and the staff team, the lines of accountability are not clear and there is no clarity about who is in day to day control of the home. The registered provider makes announced and unannounced visits to the home, several days a week and undertakes Regulation 26 visits on a monthly The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 22 basis. The registered provider’s endeavours to recruit a suitably competent and qualified person are acknowledged. However, it is of serious concern to the Commission that there has been no registered manager in the home for more than ten months and the Commission are in ongoing discussions with the registered provider. From discussions with staff it was evident that there are opportunities for ad hoc supervision and regular staff meetings, but there was no evidence that staff, both nursing and care staff, receive regular formal supervision. Supervision should cover all aspects of practice; philosophy of care in the home; and career development needs, and all staff should be supervised as part of the normal management process on a continuous basis. The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 3 x x 2 x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 1 1 x x x 2 x x The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 18 Regulation 13 & 18 Requirement It is a requirement that training in adult protection issues/ abuse awareness and the rights and choices of individuals, is extended to include all ancilliary and administrative staff working in the home( timescale of 31/12/04 and 31/05/05 not met) The registered provider must conduct the home as to maximise residents individual capacity to exercise personal autonomy and choice. Any such decisions made to limit this must be based on a risk assessment of the individuals vulnerability with evidence of regular reviews. (timescale of 31/03/05 not met) The registered provider must appoint a suitably qualified, competent and experienced person to manage the home and submit an application for registration of this person as manager with the Commission. (timescale of 31/05/05 not met) The home must ensure that any prescribed treatments or changes in medication for residents, are effected without delay, and that appropriate and Version 1.30 Timescale for action 30/09/05 2. 14 12 30/09/05 3. 31 & 32 8, 9 & 10 30/11/05 4. 8 12 & 13 22/08/05 and ongoing The Chestnuts Nursing & Residential Care Home Page 25 G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc 5. 12 16 6. 15 & 27 12 & 18 7. 16 22 8. 9. 22 36 23 18 timely action is taken to address such delays to ensure that the health care needs of residents are adequately met. More consideration must be given to planning individual and small group activities to ensure that all residents have a sufficiently stimulating and varied choice of activities. Staffing levels at meal times must be sufficient for residents to be assisted where necessary, whilst encouraging independent eating for as long as possible. The complaint policy/procedure must be amended to include information for referring a complaint to the Commission, at any stage, should the complainant wish to do so. Suitable provision must be made for the appropriate storage of aids and other equipment. Formal supervision systems must be fully implemented in accordance with Regulation 18 of the Care Homes Regulations 2001 and Standard 36.3 of the National Minimum Standards. 31/10/05 22/08/05 and ongoing 30/09/05 30/09/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Chestnuts Nursing & Residential Care Home G55_S0000025950_Chestnuts_V233934_210605_Stage 4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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